Die Bewertung des Rehabilitationsprozesses mittels des Peer-Review-Verfahrens: Methodische Prüfung und Ergebnisse der Erhebungsrunde 2000/2001 in den somatischen Indikationsbereichen

Farin, Erik; Carl, Casey; Lichtenberg, Stephanie; Wh, Jäckel; Maier-Riehle, B; Rütten-Köppel, E.

doi:10.1055/s-2003-45461

Cited by 8 publications

(1 citation statement)

References 12 publications

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“…Besides the conventional interpretation standards we adapted our reliability interpretation based on similar research contexts as has been proposed in the literature [41]. For this purpose, the reliability (r w ) of our main criterion was compared to peer review results from the external quality assurance programme in inpatient and outpatient medical rehabilitation in Germany [42]. Compared to this peer review, the reliability of the superordinate criterion is similar to the reliability coefficients of the peer review for the medical fields of orthopaedics (r w : 0.39 versus 0.35) and neurology/psychiatry (r w : 0.39 versus 0.30).…”

Section: Discussionmentioning

confidence: 99%

An instrument for quality assurance in work capacity evaluation: development, evaluation, and inter-rater reliability

Strahl

Gerlich

Alpers

et al. 2019

BMC Health Serv Res

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Background Employees insured in pension insurance, who are incapable of working due to ill health, are entitled to a disability pension. To assess whether an individual meets the medical requirements to be considered as disabled, a work capacity evaluation is conducted. However, there are no official guidelines on how to perform an external quality assurance for this evaluation process. Furthermore, the quality of medical reports in the field of insurance medicine can vary substantially, and systematic evaluations are scarce. Reliability studies using peer review have repeatedly shown insufficient ability to distinguish between high, moderate and low quality. Considering literature recommendations, we developed an instrument to examine the quality of medical experts’ reports. Methods The peer review manual developed contains six quality domains (formal structure, clarity, transparency, completeness, medical-scientific principles, and efficiency) comprising 22 items. In addition, a superordinate criterion (survey confirmability) rank the overall quality and usefulness of a report. This criterion evaluates problems of inner logic and reasoning. Development of the manual was assisted by experienced physicians in a pre-test. We examined the observable variance in peer judgements and reliability as the most important outcome criteria. To evaluate inter-rater reliability, 20 anonymous experts’ reports detailing the work capacity evaluation were reviewed by 19 trained raters (peers). Percentage agreement and Kendall’s W, a reliability measure of concordance between two or more peers, were calculated. A total of 325 reviews were conducted. Results Agreement of peer judgements with respect to the superordinate criterion ranged from 29.2 to 87.5%. Kendall’s W for the quality domain items varied greatly, ranging from 0.09 to 0.88. With respect to the superordinate criterion, Kendall’s W was 0.39, which indicates fair agreement. The results of the percentage agreement revealed systemic peer preferences for certain deficit scale categories. Conclusion The superordinate criterion was not sufficiently reliable. However, in comparison to other reliability studies, this criterion showed an equivalent reliability value. This report aims to encourage further efforts to improve evaluation instruments. To reduce disagreement between peer judgments, we propose the revision of the peer review instrument and the development and implementation of a standardized rater training to improve reliability. Electronic supplementary material The online version of this article (10.1186/s12913-019-4387-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

An instrument for quality assurance in work capacity evaluation: development, evaluation, and inter-rater reliability

Strahl

Gerlich

Alpers

et al. 2019

BMC Health Serv Res

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Qualitätssicherung und Qualitätsmanagement in der medizinischen Rehabilitation

Farin

Jäckel

2011

Bundesgesundheitsbl.

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External quality assurance in medical rehabilitation is characterized by the programs of Germany's two largest providers of rehabilitation (the German pension insurance and the statutory health insurance). The programs were developed with considerable input from scientific institutes. Their strengths lie in measuring several relevant dimensions of quality, the comprehensive implementation for nearly all illnesses treated, integration of the patient perspective, and realization of prospective study designs with follow-up. Weaknesses include low relevance for patient allocation and compensation, the absence of systematic evaluations, and a lack of published patient information on the results of the quality measurements. Internal quality management in medical rehabilitation is regulated by sweeping legal guidelines. Since 2009, a statutory agreement has been in effect which includes a provision that all inpatient rehabilitation centers must be certified by October 2012. Areas for potential improvements in internal quality management processes include an improved theoretical basis, higher specificity for rehabilitation, and a more transparent, methodically improved structure of certification procedures.

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Evaluation der Durchgangsarztberichte in der Deutschen Gesetzlichen Unfallversicherung – Methodik und Ergebnisse eines Peer-Review-Verfahrens

et al. 2020

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Hintergrund Durch eine bundesweite Beurteilung von Durchgangsarzt(D)-Berichten sollte die Dokumentationsqualität im Durchgangsarztverfahren der Deutschen Gesetzlichen Unfallversicherung (DGUV) systematisch erfasst werden. Peer-Review-Verfahren sind bewährte Instrumente zur Sicherung der Prozessqualität. Material und Methoden Für eingeschlossene D‑Ärzte wurden zufällig 30 D-Berichte mit besonderer Heilbehandlung aus dem Jahr 2017 ausgewählt, anonymisiert und webbasiert von einem zufällig zugeteilten Beurteiler (Peer) mit einer Checkliste bewertet. Diese umfasste 9 Beurteilungskategorien mit dichotomem Antwortformat (Mangel/kein Mangel). Zur Gesamteinschätzung wurde für jeden D‑Bericht eine Gesamtnote („sehr gut“ bis „ungenügend“) vergeben. Ergebnisse Insgesamt bewerteten 82 Peers 30.384 D‑Berichte. Jeder dritte D‑Bericht wies keine Mängel auf. Die häufigsten Mängel waren in der Beurteilungskategorie „Angaben zum Unfall“ zu beobachten. Die durchschnittliche Gesamtnote betrug 2,6, wobei es auf der Ebene der evaluierten D‑Ärzte deutliche Qualitätsunterschiede gab (beste: 1,5; schlechteste: 4,1). Alle evaluierten D‑Ärzte erhielten individuelle Qualitätsberichte, in denen die Kernergebnisse beschrieben wurden. Schlussfolgerung Das erste bundesweite Peer-Review der DGUV konnte sich als praktikables und valides Qualitätssicherungsverfahren für D‑Berichte bewähren. Die Qualität der Berichte kann allgemein als gut eingeschätzt werden. Die DGUV plant, das Verfahren unter Berücksichtigung weiterer D‑Arzt-Gruppen zu wiederholen.

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Die Bewertung des Rehabilitationsprozesses mittels des Peer-Review-Verfahrens: Methodische Prüfung und Ergebnisse der Erhebungsrunde 2000/2001 in den somatischen Indikationsbereichen

Cited by 8 publications

References 12 publications

An instrument for quality assurance in work capacity evaluation: development, evaluation, and inter-rater reliability

An instrument for quality assurance in work capacity evaluation: development, evaluation, and inter-rater reliability

Qualitätssicherung und Qualitätsmanagement in der medizinischen Rehabilitation

Evaluation der Durchgangsarztberichte in der Deutschen Gesetzlichen Unfallversicherung – Methodik und Ergebnisse eines Peer-Review-Verfahrens

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